Objectives-To determine general practitioners' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour.

Design-Visits by audit facilitators to general practices after feedback of details of rates of referral to hospital derived from annual reports in general practice.

Setting-92 general practices in East Anglia

Results

General practitioners judged that access to specialis care, the individual skill of general practitioners, patient demand, and fear of litigation were major determinants of referral behaviour.